COVID-19 hit nursing homes with a situation that they “were not equipped to handle,” according to David Coppins, CEO and co-founder of IntelyCare, a workforce management company specializing in post-acute care. In an interview with DailyNurse, Coppins discussed the battle that nursing homes have had to confront during the pandemic, and Pennsylvania CNA Christine Pepple offered a frontline perspective.
DailyNurse: Can you list the factors that make nursing homes so vulnerable to the pandemic?
“Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital.”
David Coppins, CEO, IntelyCare
David Coppins: “Most healthcare workers would tell you that they were not adequately prepared to handle this virus. It has been traumatic across the board. But the nursing home community has experienced incredible loss during the pandemic, and it feels as if they have been wrongfully blamed for that loss. They were thrust into a situation they were not equipped to handle.
Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital. Hospitals are designed with the assumption that everyone could have an infectious disease, and their workers also operate under that assumption. Nursing homes take what precautions they can, of course, but they do not have the equipment hospitals do, and their workers typically deal with the management of chronic conditions.
In the first wave, when there was a desperate need to get healthcare heroes PPE, hospitals had the purchasing power to acquire PPE quickly. Nursing homes simply don’t have that same purchasing power, and were effectively left to scramble for what little PPE remained – often times at 10x the typical price. There was also widespread movement from the public to get all available PPE to hospitals – you had people buying up N95s and donating them to their local hospital. The nursing homes did not benefit from public support in the same way.
It also is important to note that the nursing home population is the most at risk of all patients. It’s largely geriatric residents, or people living with chronic conditions. These folks have multiple risk factors for COVID-19. The care at nursing homes is also very touch-oriented. There are multiple CNAs in and out of rooms helping residents with teeth brushing, feeding and washing, and those CNAs, as I mentioned, were not afforded proper PPE, and were forced to use their PPE over and over again.
Finally, it bears saying that nursing homes struggled with staffing prior to the pandemic. The pandemic only exacerbated their short-staffing problem. Hospitals were impacted as well, but in most cases, hospitals canceled elective procedures and were able to re-allocate staffing resources to COVID-19 dedicated floors. Nursing homes did not have this same pool of people to rely on – they’re only fall back was agency staff which was also severely taxed.
While there was no ideal situation to be in during the pandemic, nursing homes found themselves in a uniquely unfortunate one – they didn’t have the financial resources, the PPE, or the workforce levels to cope.”
DN: What are the key lessons learned from the initial experience during the first wave of COVID-19? What measures are being taken to make nursing homes safer for nurses and residents?
“To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”
David Coppins, IntelyCare CEO
Coppins: “At the start, there was a rationing of supplies. The CDC recommended that nursing home staff refrain from using masks and gowns for every resident, and they also recommended the reuse of the same mask for long periods of time. And, nursing homes are very touch-oriented – which facilitated the spread of the virus from patient to provider. That was the first problem.
Due to resourcing and staffing issues, some facilities struggled to maintain COVID-19 specific units. While facilities did have COVID-19 specific units, they were not always able to adequately isolate workers and residents to those units. And hospitals were also sending COVID-19 patients to nursing facilities, which, in some instances, introduced COVID-19 to previously unexposed populations.
When we talk about measures to fix this problem, they’re expensive ones. We’re talking about the high cost to redesign facilities for infection control, and affording a higher capacity of PPE. Ultimately, the biggest takeaway is that the government should have stepped in faster to get necessary PPE to nursing homes. They simply did not have the purchasing power to compete with hospitals.
To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”
DN: Have nursing homes started to benefit from the various state and federal funding efforts?
Coppins: “There are various state and federal funding efforts to help out nursing facilities – but those funds were exhausted through PPE price gouging, paying for agency staffing, and the high cost of testing. It was a short-term solution. Those funds are running out, and as far as anyone can tell, there is no second wave stimulus money on the horizon. These facilities are going to be scrambling for PPE and staffing again soon enough.”
DN: What are nursing homes doing to counteract the CNA staffing shortage? Can CNAs expect higher wages or bonuses?
Coppins: “Some pay rates have gone up. Right now, nursing homes simply don’t have the cash flow to put towards recruiting and staffing. And CMS reimbursement rates haven’t changed – they need to be reevaluated and updated to match the current demand.
Staffing levels are still recovering from the unemployment act. It blew up CNA shortages. The indiscriminate application of the federal bonus had an unintended catastrophic effect on CNA staffing. Many CNAs stayed home and out of the workforce while there was a desperate need for people to work.
We may see an increase in CNAs working in the coming months. Unfortunately, there have been massive layoffs in the service industry (restaurants, retail, entertainment, etc). So you have a large population of people in need of work. Nursing homes might be an appealing prospect for those populations, and there are plenty of programs out there trying to quickly recruit and train new CNAs. But I think it will be some time before we see if this has any impact on the staffing shortage.”
“Our Residents Need Us” — A CNA’s Perspective on Nursing Homes and Covid
DailyNurse also asked Pennsylvania CNA Christine Pepple for her first-hand view from the nursing home frontlines.
DailyNurse: How has the pandemic changed the working routine of CNAs? How has it changed the way they interact with nursing home residents?
Christine Pepple: “For me, it’s really just wearing the PPE and being aware of new protocols. If I have been working at a facility that has COVID-19 exposure, sometimes I will be restricted from working at other facilities. Now I am just wearing a mask and eyewear. Earlier in the pandemic, I was head-to-toe in PPE, including a plastic gown. It was so uncomfortable.
But as for how I’ve interacted with residents, not much has changed. I have a job to do. And the residents need my care. This has been so hard on them. Luckily, visitations are coming back, and we’re now able to take them to the dining room and they can get their hair done.”
DN: How have CNAs been coping with the hardships of working during the pandemic?
“Luckily, the facilities have our backs.”
Christina Pepple, CNA
Pepple: “The hardest thing for me was the stigma. I wasn’t really able to see friends and family because I was working with COVID-19 on a regular basis. It’s been hard.
Luckily, the facilities have our backs. They have all gone above and beyond to make sure we were taken care of, and the residents were taken care of. It’s good to see some of the activities opening up and having the residents get to see each other again.”
DN: Do nursing home workers feel better prepared for the next wave of COVID?
“The facilities I have been working with have been so on top of it.”
Christine Pepple, CNA
Pepple: “We know what to expect now. We’re resilient. Nurses and nursing assistants are going to continue to do their jobs because our residents need us.
We are more prepared now. It feels like we have a lot of PPE and we have more structure now than we did at the beginning. When they bring a resident in from the hospital they quarantine for two weeks on the COVID-19 wing. If you’re working there, you wear a gown, masks, and protective eyewear. And if you’re on a wing where there’s no COVID-19, we’re just wearing eyewear and masks. We’re also getting tested every week – the facilities I have been working with have been so on top of it.”
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